Anesthesia Coding Alert

Question: The hospital admitted a patient for pre-term labor. Our anesthesiologist evaluated her and diagnosed seizure (postictal) eclampsia. He performed the normal patient exam, administered MAC and continued to monitor the patient and baby (including monitoring fetal heart rate and monitoring the patient's blood pressure until it decreased). Documentation indicates that the anesthesiologist was present for the monitoring, but not for the actual labor and delivery.

The anesthesiologist indicated verbally that there was a comprehensive H&P of high complexity. Documentation does not support the criteria for a high-level visit, and I don't think charging an H&P is appropriate. How should I code this case?


New Hampshire Subscriber

Answer: This definitely is a unique scenario. ASA guidelines state, "Monitored anesthesia care is a physician service provided to an individual patient. It should be subject to the same level of reimbursement as general or regional anesthesia. Accordingly, the ASA Relative Value Guide provides for the use of proper basic procedural units, time units and modifier units as the basis for determining reimbursement."

Given these guidelines for MAC, you could report 01999 (Unlisted anesthesia procedure[s]) including time and modifier units. The tricky part will be determining how many base units to assign. Once you decide the appropriate base units, include supporting documentation with the claim (such as the anesthesia record and a letter of explanation from the anesthesiologist outlining why anesthesia services were requested).

Remember that the patient's history and physical is part of the anesthesia service and cannot be billed separately.